St. Barnabas Hospital

All Charges

Charge

Type

Setting

Price

ARTX LO-PRO SCRW SS 3.5X14MM CRTX

Facility

$35.00

Service Code	HCPCS C1713
Hospital Charge Code	40207454
Hospital Revenue Code	278
Min. Negotiated Rate	$17.50
Max. Negotiated Rate	$17.50
Rate for Payer: Hamaspik Choice Inc Medicaid	$17.50
Rate for Payer: Hamaspik Choice Inc Medicare	$17.50

ARTX LO-PRO SCRW SS 3.5X14MM CRTX

Facility

$35.00

Service Code	HCPCS C1713
Hospital Charge Code	40207454
Hospital Revenue Code	278
Min. Negotiated Rate	$12.25
Max. Negotiated Rate	$134.20
Rate for Payer: 1199SEIU National Benefit Fund Commercial	$19.25
Rate for Payer: Aetna Gatekeeper/Non-Gatekeeper	$134.20
Rate for Payer: Aetna Government	$134.20
Rate for Payer: Brighton Health Commercial	$21.00
Rate for Payer: Cigna HMO/Network Benefit Plan/Open Access	$17.50
Rate for Payer: Cigna LocalPlus Benefit Plan	$20.12
Rate for Payer: EmblemHealth Commercial	$17.50
Rate for Payer: Fidelis Medicare Advantage	$36.75
Rate for Payer: Group Health Inc Commercial	$17.50
Rate for Payer: Group Health Inc Medicare	$12.25
Rate for Payer: Hamaspik Choice Inc Medicaid	$17.50
Rate for Payer: Hamaspik Choice Inc Medicare	$17.50
Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual	$22.75

ASA/ANTIPLAT THER USED

Facility

$0.01

Service Code	HCPCS G8598
Hospital Charge Code	30307870
Hospital Revenue Code	510
Min. Negotiated Rate	$0.01
Max. Negotiated Rate	$250.00
Rate for Payer: 1199SEIU National Benefit Fund Commercial	$0.01
Rate for Payer: Aetna Gatekeeper/Non-Gatekeeper	$0.01
Rate for Payer: Aetna Government	$0.01
Rate for Payer: Brighton Health Commercial	$233.00
Rate for Payer: Cigna HMO/Network Benefit Plan/Open Access	$204.58
Rate for Payer: Cigna LocalPlus Benefit Plan	$173.89
Rate for Payer: Group Health Inc Commercial	$250.00
Rate for Payer: Group Health Inc Medicare	$250.00
Rate for Payer: Hamaspik Choice Inc Medicaid	$0.01
Rate for Payer: Hamaspik Choice Inc Medicare	$0.01
Rate for Payer: United Healthcare Commercial	$222.00

ASAHI GRAND SLAM 300CM

Facility

$75.00

Service Code	HCPCS C1769
Hospital Charge Code	40005242
Hospital Revenue Code	278
Min. Negotiated Rate	$4.08
Max. Negotiated Rate	$78.75
Rate for Payer: 1199SEIU National Benefit Fund Commercial	$41.25
Rate for Payer: Aetna Gatekeeper/Non-Gatekeeper	$4.08
Rate for Payer: Aetna Government	$4.08
Rate for Payer: Brighton Health Commercial	$45.00
Rate for Payer: Cigna HMO/Network Benefit Plan/Open Access	$37.50
Rate for Payer: Cigna LocalPlus Benefit Plan	$43.12
Rate for Payer: EmblemHealth Commercial	$37.50
Rate for Payer: Fidelis Medicare Advantage	$78.75
Rate for Payer: Group Health Inc Commercial	$37.50
Rate for Payer: Group Health Inc Medicare	$26.25
Rate for Payer: Hamaspik Choice Inc Medicaid	$37.50
Rate for Payer: Hamaspik Choice Inc Medicare	$37.50
Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual	$48.75

ASAHI GRAND SLAM 300CM

Facility

$75.00

Service Code	HCPCS C1769
Hospital Charge Code	40005242
Hospital Revenue Code	278
Min. Negotiated Rate	$37.50
Max. Negotiated Rate	$37.50
Rate for Payer: Hamaspik Choice Inc Medicaid	$37.50
Rate for Payer: Hamaspik Choice Inc Medicare	$37.50

ASCENSION ORTHO 6.0MM NEUROLAC NG

Facility

$2,090.00

Hospital Charge Code	40205543
Hospital Revenue Code	270
Min. Negotiated Rate	$731.50
Max. Negotiated Rate	$1,672.00
Rate for Payer: 1199SEIU National Benefit Fund Commercial	$1,149.50
Rate for Payer: Aetna Gatekeeper/Non-Gatekeeper	$1,045.00
Rate for Payer: Aetna Government	$1,045.00
Rate for Payer: Brighton Health Commercial	$1,567.50
Rate for Payer: Cigna HMO/Network Benefit Plan/Open Access	$1,672.00
Rate for Payer: Cigna LocalPlus Benefit Plan	$1,421.20
Rate for Payer: Group Health Inc Commercial	$1,045.00
Rate for Payer: Group Health Inc Medicare	$731.50
Rate for Payer: Hamaspik Choice Inc Medicaid	$1,045.00
Rate for Payer: Hamaspik Choice Inc Medicare	$1,045.00

ASCENT PRIMARY FEMORAL

Facility

$5,132.00

Service Code	HCPCS C1776
Hospital Charge Code	40202252
Hospital Revenue Code	278
Min. Negotiated Rate	$2,566.00
Max. Negotiated Rate	$2,566.00
Rate for Payer: Hamaspik Choice Inc Medicaid	$2,566.00
Rate for Payer: Hamaspik Choice Inc Medicare	$2,566.00

ASCENT PRIMARY FEMORAL

Facility

$5,132.00

Service Code	HCPCS C1776
Hospital Charge Code	40202252
Hospital Revenue Code	278
Min. Negotiated Rate	$339.17
Max. Negotiated Rate	$5,388.60
Rate for Payer: 1199SEIU National Benefit Fund Commercial	$2,822.60
Rate for Payer: Aetna Gatekeeper/Non-Gatekeeper	$339.17
Rate for Payer: Aetna Government	$339.17
Rate for Payer: Brighton Health Commercial	$3,079.20
Rate for Payer: Cigna HMO/Network Benefit Plan/Open Access	$2,566.00
Rate for Payer: Cigna LocalPlus Benefit Plan	$2,950.90
Rate for Payer: EmblemHealth Commercial	$2,566.00
Rate for Payer: Fidelis Medicare Advantage	$5,388.60
Rate for Payer: Group Health Inc Commercial	$2,566.00
Rate for Payer: Group Health Inc Medicare	$1,796.20
Rate for Payer: Hamaspik Choice Inc Medicaid	$2,566.00
Rate for Payer: Hamaspik Choice Inc Medicare	$2,566.00
Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual	$3,335.80

ASCENT PRIMARY FEMORAL RT MED

Facility

$5,132.00

Service Code	HCPCS C1776
Hospital Charge Code	40202253
Hospital Revenue Code	278
Min. Negotiated Rate	$339.17
Max. Negotiated Rate	$5,388.60
Rate for Payer: 1199SEIU National Benefit Fund Commercial	$2,822.60
Rate for Payer: Aetna Gatekeeper/Non-Gatekeeper	$339.17
Rate for Payer: Aetna Government	$339.17
Rate for Payer: Brighton Health Commercial	$3,079.20
Rate for Payer: Cigna HMO/Network Benefit Plan/Open Access	$2,566.00
Rate for Payer: Cigna LocalPlus Benefit Plan	$2,950.90
Rate for Payer: EmblemHealth Commercial	$2,566.00
Rate for Payer: Fidelis Medicare Advantage	$5,388.60
Rate for Payer: Group Health Inc Commercial	$2,566.00
Rate for Payer: Group Health Inc Medicare	$1,796.20
Rate for Payer: Hamaspik Choice Inc Medicaid	$2,566.00
Rate for Payer: Hamaspik Choice Inc Medicare	$2,566.00
Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual	$3,335.80

ASCENT PRIMARY FEMORAL RT MED

Facility

$5,132.00

Service Code	HCPCS C1776
Hospital Charge Code	40202253
Hospital Revenue Code	278
Min. Negotiated Rate	$2,566.00
Max. Negotiated Rate	$2,566.00
Rate for Payer: Hamaspik Choice Inc Medicaid	$2,566.00
Rate for Payer: Hamaspik Choice Inc Medicare	$2,566.00

ASCOPE3 SLIM S VIDEOSCOPE

Facility

$707.50

Hospital Charge Code	64903732
Hospital Revenue Code	270
Min. Negotiated Rate	$247.62
Max. Negotiated Rate	$566.00
Rate for Payer: 1199SEIU National Benefit Fund Commercial	$389.12
Rate for Payer: Aetna Gatekeeper/Non-Gatekeeper	$353.75
Rate for Payer: Aetna Government	$353.75
Rate for Payer: Brighton Health Commercial	$530.62
Rate for Payer: Cigna HMO/Network Benefit Plan/Open Access	$566.00
Rate for Payer: Cigna LocalPlus Benefit Plan	$481.10
Rate for Payer: Group Health Inc Commercial	$353.75
Rate for Payer: Group Health Inc Medicare	$247.62
Rate for Payer: Hamaspik Choice Inc Medicaid	$353.75
Rate for Payer: Hamaspik Choice Inc Medicare	$353.75

ASCORBIC ACID 25000 MG/50ML IV SOLN [160186]

Facility

$6.49

Service Code	NDC 67157010150
Hospital Charge Code	67157010150
Hospital Revenue Code	278
Min. Negotiated Rate	$3.25
Max. Negotiated Rate	$3.25
Rate for Payer: Hamaspik Choice Inc Medicaid	$3.25
Rate for Payer: Hamaspik Choice Inc Medicare	$3.25

ASCORBIC ACID 25000 MG/50ML IV SOLN [160186]

Facility

$6.49

Service Code	NDC 67157010150
Hospital Charge Code	67157010150
Hospital Revenue Code	278
Min. Negotiated Rate	$2.27
Max. Negotiated Rate	$6.82
Rate for Payer: 1199SEIU National Benefit Fund Commercial	$3.57
Rate for Payer: Aetna Gatekeeper/Non-Gatekeeper	$3.25
Rate for Payer: Aetna Government	$3.25
Rate for Payer: Brighton Health Commercial	$3.90
Rate for Payer: Cigna HMO/Network Benefit Plan/Open Access	$3.25
Rate for Payer: Cigna LocalPlus Benefit Plan	$3.73
Rate for Payer: EmblemHealth Commercial	$3.25
Rate for Payer: Fidelis Medicare Advantage	$6.82
Rate for Payer: Group Health Inc Commercial	$3.25
Rate for Payer: Group Health Inc Medicare	$2.27
Rate for Payer: Hamaspik Choice Inc Medicaid	$3.25
Rate for Payer: Hamaspik Choice Inc Medicare	$3.25
Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual	$4.22

ASCORBIC ACID 500 MG TAB

Facility

$0.06

Hospital Charge Code	41654028
Hospital Revenue Code	250
Min. Negotiated Rate	$0.02
Max. Negotiated Rate	$0.05
Rate for Payer: 1199SEIU National Benefit Fund Commercial	$0.03
Rate for Payer: Aetna Gatekeeper/Non-Gatekeeper	$0.03
Rate for Payer: Aetna Government	$0.03
Rate for Payer: Brighton Health Commercial	$0.05
Rate for Payer: Cigna HMO/Network Benefit Plan/Open Access	$0.05
Rate for Payer: Cigna LocalPlus Benefit Plan	$0.04
Rate for Payer: Group Health Inc Commercial	$0.03
Rate for Payer: Group Health Inc Medicare	$0.02
Rate for Payer: Hamaspik Choice Inc Medicaid	$0.03
Rate for Payer: Hamaspik Choice Inc Medicare	$0.03
Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual	$0.04

ASCORBIC ACID 500 MG TAB

Facility

$0.06

Hospital Charge Code	41644028
Hospital Revenue Code	250
Min. Negotiated Rate	$0.02
Max. Negotiated Rate	$0.05
Rate for Payer: 1199SEIU National Benefit Fund Commercial	$0.03
Rate for Payer: Aetna Gatekeeper/Non-Gatekeeper	$0.03
Rate for Payer: Aetna Government	$0.03
Rate for Payer: Brighton Health Commercial	$0.05
Rate for Payer: Cigna HMO/Network Benefit Plan/Open Access	$0.05
Rate for Payer: Cigna LocalPlus Benefit Plan	$0.04
Rate for Payer: Group Health Inc Commercial	$0.03
Rate for Payer: Group Health Inc Medicare	$0.02
Rate for Payer: Hamaspik Choice Inc Medicaid	$0.03
Rate for Payer: Hamaspik Choice Inc Medicare	$0.03
Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual	$0.04

ASCORBIC ACID INJ, 500MG/ML

Facility

$23.00

Hospital Charge Code	41655869
Hospital Revenue Code	250
Min. Negotiated Rate	$8.05
Max. Negotiated Rate	$18.40
Rate for Payer: 1199SEIU National Benefit Fund Commercial	$12.65
Rate for Payer: Aetna Gatekeeper/Non-Gatekeeper	$11.50
Rate for Payer: Aetna Government	$11.50
Rate for Payer: Brighton Health Commercial	$17.25
Rate for Payer: Cigna HMO/Network Benefit Plan/Open Access	$18.40
Rate for Payer: Cigna LocalPlus Benefit Plan	$15.64
Rate for Payer: Group Health Inc Commercial	$11.50
Rate for Payer: Group Health Inc Medicare	$8.05
Rate for Payer: Hamaspik Choice Inc Medicaid	$11.50
Rate for Payer: Hamaspik Choice Inc Medicare	$11.50
Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual	$14.95

ASCORBIC ACID INJ, 500MG/ML

Facility

$23.00

Hospital Charge Code	41645869
Hospital Revenue Code	250
Min. Negotiated Rate	$8.05
Max. Negotiated Rate	$18.40
Rate for Payer: 1199SEIU National Benefit Fund Commercial	$12.65
Rate for Payer: Aetna Gatekeeper/Non-Gatekeeper	$11.50
Rate for Payer: Aetna Government	$11.50
Rate for Payer: Brighton Health Commercial	$17.25
Rate for Payer: Cigna HMO/Network Benefit Plan/Open Access	$18.40
Rate for Payer: Cigna LocalPlus Benefit Plan	$15.64
Rate for Payer: Group Health Inc Commercial	$11.50
Rate for Payer: Group Health Inc Medicare	$8.05
Rate for Payer: Hamaspik Choice Inc Medicaid	$11.50
Rate for Payer: Hamaspik Choice Inc Medicare	$11.50
Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual	$14.95

ASEPTO SET

Facility

$28.35

Hospital Charge Code	40200360
Hospital Revenue Code	270
Min. Negotiated Rate	$9.92
Max. Negotiated Rate	$22.68
Rate for Payer: 1199SEIU National Benefit Fund Commercial	$15.59
Rate for Payer: Aetna Gatekeeper/Non-Gatekeeper	$14.18
Rate for Payer: Aetna Government	$14.18
Rate for Payer: Brighton Health Commercial	$21.26
Rate for Payer: Cigna HMO/Network Benefit Plan/Open Access	$22.68
Rate for Payer: Cigna LocalPlus Benefit Plan	$19.28
Rate for Payer: Group Health Inc Commercial	$14.18
Rate for Payer: Group Health Inc Medicare	$9.92
Rate for Payer: Hamaspik Choice Inc Medicaid	$14.18
Rate for Payer: Hamaspik Choice Inc Medicare	$14.18

ASMANEX 110MCG

Facility

$49.00

Hospital Charge Code	41658140
Hospital Revenue Code	250
Min. Negotiated Rate	$17.15
Max. Negotiated Rate	$39.20
Rate for Payer: 1199SEIU National Benefit Fund Commercial	$26.95
Rate for Payer: Aetna Gatekeeper/Non-Gatekeeper	$24.50
Rate for Payer: Aetna Government	$24.50
Rate for Payer: Brighton Health Commercial	$36.75
Rate for Payer: Cigna HMO/Network Benefit Plan/Open Access	$39.20
Rate for Payer: Cigna LocalPlus Benefit Plan	$33.32
Rate for Payer: Group Health Inc Commercial	$24.50
Rate for Payer: Group Health Inc Medicare	$17.15
Rate for Payer: Hamaspik Choice Inc Medicaid	$24.50
Rate for Payer: Hamaspik Choice Inc Medicare	$24.50
Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual	$31.85

ASMANEX 220MCG

Facility

$0.02

Hospital Charge Code	41658141
Hospital Revenue Code	250
Min. Negotiated Rate	$0.01
Max. Negotiated Rate	$0.02
Rate for Payer: 1199SEIU National Benefit Fund Commercial	$0.01
Rate for Payer: Aetna Gatekeeper/Non-Gatekeeper	$0.01
Rate for Payer: Aetna Government	$0.01
Rate for Payer: Brighton Health Commercial	$0.02
Rate for Payer: Cigna HMO/Network Benefit Plan/Open Access	$0.02
Rate for Payer: Cigna LocalPlus Benefit Plan	$0.01
Rate for Payer: Group Health Inc Commercial	$0.01
Rate for Payer: Group Health Inc Medicare	$0.01
Rate for Payer: Hamaspik Choice Inc Medicaid	$0.01
Rate for Payer: Hamaspik Choice Inc Medicare	$0.01
Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual	$0.01

ASMANEX 220MCG

Facility

$0.02

Hospital Charge Code	41648141
Hospital Revenue Code	250
Min. Negotiated Rate	$0.01
Max. Negotiated Rate	$0.02
Rate for Payer: 1199SEIU National Benefit Fund Commercial	$0.01
Rate for Payer: Aetna Gatekeeper/Non-Gatekeeper	$0.01
Rate for Payer: Aetna Government	$0.01
Rate for Payer: Brighton Health Commercial	$0.02
Rate for Payer: Cigna HMO/Network Benefit Plan/Open Access	$0.02
Rate for Payer: Cigna LocalPlus Benefit Plan	$0.01
Rate for Payer: Group Health Inc Commercial	$0.01
Rate for Payer: Group Health Inc Medicare	$0.01
Rate for Payer: Hamaspik Choice Inc Medicaid	$0.01
Rate for Payer: Hamaspik Choice Inc Medicare	$0.01
Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual	$0.01

ASNIS 8.0MMX75MM CANN SCREW

Facility

$441.00

Service Code	HCPCS C1713
Hospital Charge Code	40205629
Hospital Revenue Code	278
Min. Negotiated Rate	$220.50
Max. Negotiated Rate	$220.50
Rate for Payer: Hamaspik Choice Inc Medicaid	$220.50
Rate for Payer: Hamaspik Choice Inc Medicare	$220.50

ASNIS 8.0MMX75MM CANN SCREW

Facility

$441.00

Service Code	HCPCS C1713
Hospital Charge Code	40205629
Hospital Revenue Code	278
Min. Negotiated Rate	$134.20
Max. Negotiated Rate	$463.05
Rate for Payer: 1199SEIU National Benefit Fund Commercial	$242.55
Rate for Payer: Aetna Gatekeeper/Non-Gatekeeper	$134.20
Rate for Payer: Aetna Government	$134.20
Rate for Payer: Brighton Health Commercial	$264.60
Rate for Payer: Cigna HMO/Network Benefit Plan/Open Access	$220.50
Rate for Payer: Cigna LocalPlus Benefit Plan	$253.58
Rate for Payer: EmblemHealth Commercial	$220.50
Rate for Payer: Fidelis Medicare Advantage	$463.05
Rate for Payer: Group Health Inc Commercial	$220.50
Rate for Payer: Group Health Inc Medicare	$154.35
Rate for Payer: Hamaspik Choice Inc Medicaid	$220.50
Rate for Payer: Hamaspik Choice Inc Medicare	$220.50
Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual	$286.65

ASNIS 8.0MM X 85MM CANN SCREW

Facility

$441.00

Service Code	HCPCS C1713
Hospital Charge Code	40205630
Hospital Revenue Code	278
Min. Negotiated Rate	$134.20
Max. Negotiated Rate	$463.05
Rate for Payer: 1199SEIU National Benefit Fund Commercial	$242.55
Rate for Payer: Aetna Gatekeeper/Non-Gatekeeper	$134.20
Rate for Payer: Aetna Government	$134.20
Rate for Payer: Brighton Health Commercial	$264.60
Rate for Payer: Cigna HMO/Network Benefit Plan/Open Access	$220.50
Rate for Payer: Cigna LocalPlus Benefit Plan	$253.58
Rate for Payer: EmblemHealth Commercial	$220.50
Rate for Payer: Fidelis Medicare Advantage	$463.05
Rate for Payer: Group Health Inc Commercial	$220.50
Rate for Payer: Group Health Inc Medicare	$154.35
Rate for Payer: Hamaspik Choice Inc Medicaid	$220.50
Rate for Payer: Hamaspik Choice Inc Medicare	$220.50
Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual	$286.65

ASNIS 8.0MM X 85MM CANN SCREW

Facility

$441.00

Service Code	HCPCS C1713
Hospital Charge Code	40205630
Hospital Revenue Code	278
Min. Negotiated Rate	$220.50
Max. Negotiated Rate	$220.50
Rate for Payer: Hamaspik Choice Inc Medicaid	$220.50
Rate for Payer: Hamaspik Choice Inc Medicare	$220.50

Know your out-of-pocket cost for care.

All Charges